教育訓練對護理長授權賦能之成效探討

The Effectiveness of Education Training Programs Upon the Empowerment for Head Nurses

謝明珠(Ming- Chu Hsieh)

指導教授 ： 盧美秀

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

由於目前醫療院所面臨健保政策的種種衝擊，造成經營管理極大的挑戰與困難，而在人力成本與品質的雙重壓力下，管理者如何有效授權並賦予部屬能力，進而促使員工及組織能發揮最大的工作效能與生產力，乃是機構致勝的關鍵所在。因此，本研究主要目的在比較有接受與沒有接受授權賦能教育訓練的護理長，其單位護理人員對工作相關授權賦能的知覺感受之差異。而其授權賦能成效係採Klakovich（1995）所發展的「工作相關授權賦能量表」所測得之知覺感受分數，作為結果指標。本研究採類實驗設計法，介入實驗組護理長授權賦能教育訓練課程，共20小時。研究對象以南部某教學醫院總分院單位護理長（包括代理護理長）共21人，及工作滿半年以上的護理人員共447人。將兩院護理長（包括代理護理長）分為甲乙兩組，以抽籤方式抽出第一組即當實驗組，另一組則為控制組；而護理人員則隨著單位護理長，逕自分為實驗組與控制組。資料以t- test、卡方檢定及GEE Model等統計方法進行處理與分析。 研究結果發現：1.研究對象之基本屬性中，以年齡、本院服務年資、本單位年資及護理工作總年資等四個變項，在統計學上有非常顯著差異（p＜0.001），亦即此四個變項是本研究所需控制之干擾因子。2.研究對象之工作相關授權賦能知覺感受程度（滿分為5分），平均數在3.15~3.44之間，屬中等程度，其次量表中以相對應性最高，其次是所有權感和共同參與。3.在未控制組內成長效應與組間干擾因素時，兩組護理人員在前測、後測一及後測二，其工作相關授權賦能之知覺感受得分情形，實驗組與控制組之平均數差異性都非常小。4.在控制干擾因素及「兩組前測效應」與「控制組之成長效應」之後，以GEE 統計模式分析，比較有接受授權賦能教育訓練的護理長與沒有接受授權賦能教育訓練的護理長，其單位護理人員對工作相關授權賦能的得分變異量，包括兩組整體工作相關授權賦能及三個次量表：相對應性、共同參與及所有權感等，其結果在統計學上皆無顯著性差異（p＞0.05）。5.在控制「兩組前測效應」與「控制組之成長效應」後，在四個控制變項中，本院服務年資對兩組樣本之整體工作相關授權賦能、共同參與和所有權感比較，皆會有所影響（p＜0.05）。而年齡僅對兩組樣本之相對應性比較，會有所影響（p＜0.05）。本單位年資則對兩組樣本之所有權感比較，有所影響（p＜0.05）。 由上述結果顯示護理人員之年齡與年資等基本屬性，與工作相關授權賦能知覺感受有顯著相關，因此護理主管在帶領不同年齡與年資別的部屬時，宜強化情境領導的技巧，以促使護理人員能充分發揮所長。另外護理部門亦可多安排對護理主管及護理人員有關授權賦能的相關在職教育課程，而其教育課程之設計，除了安排在課堂中授課外，宜強化課後的定期追蹤與臨床案例之分享，以提昇整體護理部門的工作效能與工作滿意度，並強化與其他部門之團隊合作機制，進而提昇健康照護品質。

關鍵字

教育訓練 ； 授權賦能成效

並列摘要

As a result of conflicting health care policies, consequences of great challenge and difficulties are faced by today''s hospital. Under the dual pressure of manpower effectiveness and quality assurance, how the management empowers its employees to improve its staff and organization to achieve highest efficiency and productivity is the key to success. Therefore, this research''s main purposes are to compare the effectiveness of head nurses who had imposed an educational program on empowerment to that of those who didn''t and also compare their staffs'' acceptance of empowerment in their work. The effectiveness of empowerment is measured by "Reciprocal Empowerment Scale" (1995). This research is done using a controlled study. Twenty hours of empowerment training is given to head nurses who have joined the experimental group. The participants are department head nurses (including acting department head nurses) from a teaching hospital in southern Taiwan. The subjects included 21 head nurses as well as their staff members, totaling 448 people, who have had working experience for more than six months by the time the research was conducted. The head nurses are divided into two groups (Group A and Group B). The first group was randomly selected to be the experimental group, thus make the second group the control group. The results are analyzed using t-test, chi-square, and GEE Model. Result: 1. The subjects could be divided into four variables: age, time-length of employment at the hospital, time-length of stay at the department, and the number of years of work experience. These variables were the parameters that we needed to control in our experiment as they had significant statistical variance (p < 0.001). 2. The average Reciprocal Empowerment Scale (RES) scores (five-point scale) of all the subjects was between 3.15 and 3.44. Among 3 subscales, REC (reciprocity) scores highest, following that was OWN (ownership) and SYN (synergy). 3. When the growth effect within each group and the interference between groups were not controlled, for both groups, the differences between the RES averages obtained before and after experiment are not significant. 4. After the interference, pretest differential effects, and the growth effect of the control group were controlled, we analyzed the results with GEE model. Comparing the head nurses of the groups, their staffs gave scores on the work-related empowerment performance including the whole group''s RES and the three subscales: REC, SYN, and OWN. The differences between the two groups are not significant (p > 0.05). 5. After minimizing pretest differential effects and the growth effect of the control group, within the four controlling parameters, the hospital seniority have effects on RES, SYN and OWN (p < 0.05). Age affects only the REC (p<0.05). Departmental seniority affects only OWN (p < 0.05) The research shown that age and work experience of the nursing staff significantly affect the work related reciprocal empowerment. Therefore, as a manager leading a staff with varying ages and work experiences, one needs to improve one''s circumstantial leadership technique in order for one''s staff to achieve their best. Also, the nursing departments can arrange more empowerment related training programs for both their staffs and managers. The design of the programs should emphasize “regular follow-ups” and “clinical experience sharing” so to increase the work efficiency of the department as well as job satisfaction, and improve the interdepartmental cooperation, which will in turn improve the quality of our health care.

並列關鍵字

Education Training Programs ； Effectiveness of Empowerment

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